MEDICARE: JOSEPH P. BADOLATO, D.O., P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	OS005061L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000124127	OTHER	PA	HIGHMARK BLUE SHIELD
2	4474097	OTHER	PA	AETNA
3	3727345000	OTHER	PA	INDEPENDENCE BLUE CROSS PERSONAL CHOICE
4	3727345001	OTHER	PA	KEYSTONE HEALTH PLAN EAST
5	1123759	OTHER		CIGNA
6	276928	OTHER		UNITED HEALTHCARE
7	30063423	OTHER		KEYSTONE MERCY

General Provider Information

NPI Number	:	1538395009
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOSEPH P. BADOLATO, D.O., P.C.

Provider Business Mailing Address
First Line	:	1818 E PASSYUNK AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19148-2128
Country	:	US
Telephone Number	:	215-468-2553
Fax Number	:	215-468-1096

Provider Business Practice Location Address
First Line	:	1818 E PASSYUNK AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19148-2128
Country	:	US
Telephone Number	:	215-468-2553
Fax Number	:	215-468-1096

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JOSEPH P BADOLATO
Credential	:	D.O.
Telephone Number	:	215-468-2553

Provider Enumeration Date	:	06/10/2009
Last Update Date	:	09/03/2019

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